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Imaging Diagnosis

In heavily infested children, and occasionally in adults, large collections of ascarids can frequently be identified on plain films of the abdomen. The mass of worms contrasted against the gas in the bowel, usually in a distended segment, resembles a tangled group of thick cords and sometimes produces a "whirlpool" effect (Figs. 10.12 and 10.13).

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Fig. 10.12 Ascariasis of the left colon (A) and lungs (B) in a child from El Salvador, Central America. Note the large bolus of ascarids outlined by air in the descending and sigmoid colon, causing a partial intestinal obstruction. There are also patchy infiltrates in the perihilar areas and lung bases as a result of pneumonitis due to Ascaris larvae migrating throughout the lungs. (courtesy of Dr. Julio Astacio, San Salvador).

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Fig. 10.13 Large tangled masses of ascarids in the intestinal tracts of four different children. (A) A 3-year-old Puerto Rican female with abdominal pain and vomiting for 4 days without a bowel movement. Chest x-ray was negative. Plain film of the abdomen revealed a large bolus of ascarids in the cecum and the descending colon with moderate distention of the large bowel. (Courtesy of Dr. Bernardo Marquez, Puerto Rico.) (B) Masses of tangled ascarids, primarily in the left colon of a Brazilian child (Courtesy of Dr. Antonio Filho, Sao Paulo.) (C) A large bolus of worms in the cecum causing intestinal obstruction in a Central American child (Courtesy of Dr. Julio Astacio, San Salvador.) (D) A large mass of tangled ascarids in the rectum of a child from South Africa, who also had Ascaris in the common bile duct on intravenous cholangiography (see Fig. 10.28-C).

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